1306276407 NPI number — BAART COMMUNITY HEALTHCARE

Table of content: (NPI 1306276407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306276407 NPI number — BAART COMMUNITY HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAART COMMUNITY HEALTHCARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306276407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 LAKEPOINTE DR STE 117
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75057-6425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-379-3300
Provider Business Mailing Address Fax Number:
214-853-9018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 AVALON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90011-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-235-5035
Provider Business Practice Location Address Fax Number:
323-235-2023
Provider Enumeration Date:
11/26/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAUL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
214-379-3300

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  960001332 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G496230 . This is a "MEDI-CAL LEGACY NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HL290Z . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CMM70932F . This is a "CLINIC MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FU754Z . This is a "PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GB595Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".